All You Need to Know About Acid Reflux and GERD

GERD (Gastroesophageal Reflux Disease) happens when stomach acid frequently flows back into the esophagus, causing irritation and discomfort. Experiencing symptoms twice weekly or more may indicate GERD, which can lead to complications if left untreated. Learn about GERD symptoms, causes, and treatment options.

Table of Contents:

1. Symptoms of GERD
2. Symptoms in Infants
3. Causes of GERD
4. Diagnosis of GERD
5. Treatment for GERD
6. Complications of Untreated GERD
7. Frequently Asked Questions (FAQs)
8. Takeaway

Symptoms of GERD

GERD presents with various symptoms from mild to severe. Recognizing them is key for proper diagnosis and management. Common symptoms include:

1. Heartburn: A burning chest sensation, often after eating or at night, worsened by lying down.
2. Regurgitation: Sour or bitter-tasting stomach contents flowing back into the throat or mouth.
3. Dysphagia: Difficulty swallowing due to esophageal inflammation or narrowing.
4. Chronic Cough: Persistent cough, often worse at night or after meals.
5. Hoarseness or Sore Throat: Caused by acid irritating throat tissues.
6. Chest Pain: Burning discomfort that may radiate, often confused with heart issues.
7. Respiratory Symptoms: Asthma, wheezing, or pneumonia from acid reflux reaching airways.
8. Nighttime Symptoms: Disrupted sleep from coughing, regurgitation, or discomfort.

Not everyone experiences all symptoms, and severity varies. Occasional heartburn doesn’t necessarily mean GERD, but frequent symptoms warrant medical evaluation.

Symptoms in Infants

Infants with GERD may show these signs:

1. Frequent Spitting Up: Excessive vomiting after feedings with fussiness.
2. Back Arching: During or after feedings to relieve discomfort.
3. Irritability: Crying or fussiness during/after feedings.
4. Poor Weight Gain: Difficulty thriving despite adequate feeding.
5. Feeding Difficulties: Gagging, choking, or refusing food.
6. Chronic Cough/Wheezing: Respiratory issues worsening when lying down.
7. Excessive Drooling: Trouble managing saliva.
8. Ear Infections: From acid reaching the middle ear.
9. Sleep Issues: Frequent waking or restlessness.
10. Severe Respiratory Problems: Apnea or pneumonia in extreme cases.

Consult a pediatrician if GERD is suspected in an infant.

Causes of GERD

GERD occurs when the lower esophageal sphincter (LES) weakens or relaxes abnormally. Contributing factors include:

1. Hiatal Hernia: Stomach bulging into the chest weakens the LES.
2. Weak LES: Fails to prevent acid reflux.
3. Dietary Triggers: Spicy, acidic, fatty foods, chocolate, alcohol.
4. Obesity: Increases abdominal pressure.
5. Pregnancy: Hormonal changes and uterine pressure.
6. Smoking: Weakens LES and increases acid production.
7. Medications: NSAIDs, muscle relaxants, some blood pressure drugs.
8. Gastroparesis: Delayed stomach emptying increases reflux risk.
9. Connective Tissue Disorders: Rare conditions like scleroderma.

Understanding causes helps in managing GERD through lifestyle changes and treatment.

Diagnosis

GERD diagnosis involves:

1. Medical History: Symptom frequency and triggers.
2. Physical Exam: Checking for abdominal tenderness or other issues.
3. Symptom Questionnaires: Tools like GERD-Q assess severity.
4. Acid Suppression Trial: Improvement with PPIs suggests GERD.
5. pH Monitoring: Measures acid reflux frequency/duration.
6. Esophageal Manometry: Assesses LES and esophageal muscle function.
7. Endoscopy (EGD): Visualizes esophageal damage or Barrett’s esophagus.
8. Barium Swallow: X-ray to detect structural issues like hiatal hernia.
9. Impedance-pH Monitoring: Tracks acid and non-acid reflux.
10. Biopsy: Checks for Barrett’s esophagus or esophagitis.

A thorough evaluation ensures accurate diagnosis and tailored treatment. Consult a doctor for persistent symptoms.

Treatment for GERD

GERD treatment focuses on symptom relief, healing, and preventing complications:

1. Lifestyle Changes:

• Avoid trigger foods, eat smaller meals, and don’t lie down after eating.
• Lose weight if needed and elevate the head of your bed.

1. Medications:

• PPIs (omeprazole, esomeprazole): Reduce acid production.
• H2 Blockers (famotidine, ranitidine): Decrease acid.
• Antacids: Provide quick relief by neutralizing acid.
• Prokinetics (metoclopramide): Improve stomach emptying.

1. Surgery:

• Fundoplication: Wraps stomach around LES to strengthen it.
• LINX Device: Magnetic beads placed around LES to prevent reflux.

1. Endoscopic Procedures:

• Stretta: Radiofrequency energy strengthens LES.
• Endoscopic Suturing: Tightens LES with stitches.

1. Behavioral Therapy:

• Biofeedback to control esophageal muscle function.

1. Managing Complications:

• Treat esophagitis with acid suppressants.
• Monitor Barrett’s esophagus for cancer risk.

Treatment is personalized based on symptom severity and response. Regular follow-ups ensure effective management.

Complications of Untreated GERD

Untreated GERD can cause serious issues:

1. Esophagitis: Inflammation leading to ulcers or strictures.
2. Barrett’s Esophagus: Precancerous cell changes.
3. Esophageal Strictures: Narrowing causing swallowing difficulties.
4. Respiratory Problems: Pneumonia or asthma from aspiration.
5. Esophageal Cancer: Increased risk with Barrett’s esophagus.
6. Dental Erosion: Acid damages tooth enamel.
7. Chronic Lung Disease: From repeated acid inhalation.
8. Sleep Disruption: Nighttime symptoms cause fatigue.
9. Severe Esophagitis: Risk of bleeding or perforation.
10. Food Impaction: From strictures blocking food passage.

Early treatment prevents complications and improves quality of life.

Frequently Asked Questions

Common GERD questions answered:

1. What is GERD?

• Chronic acid reflux causing heartburn, regurgitation, and other symptoms.

1. GERD vs. Heartburn?

• Heartburn is a GERD symptom; GERD is the chronic condition.

1. GERD Causes?

• Weak LES, hiatal hernia, obesity, diet, smoking, medications.

1. How is GERD Diagnosed?

• Medical history, pH monitoring, endoscopy, manometry, barium swallow.

1. GERD Treatments?

• Lifestyle changes, PPIs, surgery (fundoplication, LINX), endoscopic procedures.

1. GERD Complications?

• Esophagitis, Barrett’s esophagus, strictures, respiratory issues, cancer risk.